超声引导下臂丛神经麻醉阻滞在上肢手术中的应用价值探讨

Application Value of Ultrasound Guided Brachial Plexus Block in Upper Limb Surgery

目的探讨超声引导下臂丛神经麻醉阻滞在上肢手术中的应用价值。方法选取2019年1月—2021年12月在重庆市开州区人民医院进行上肢手术且接受传统解剖定位行臂丛神经阻滞的126例患者作为传统组,选取同期进行上肢手术且接受超声引导定位行臂丛神经阻滞的174例患者作为超声组,比较两组手术相关指标。结果超声组麻醉起效时间短于传统组,神经阻麻醉持续时间长于传统组,差异均有统计学意义(P<0.05)。超声组血流量、阻力指数、搏动指数、舒张末期速度均优于传统组,差异均有统计学意义(P<0.05)。两组收缩期峰速度比较,差异无统计学意义(P>0.05)。超声组动脉压和心率在神经阻滞前、神经阻滞30 min和手术结束时比较,差异均无统计学意义(P>0.05)。传统组动脉压、心率在神经阻滞前、神经阻滞30 min和手术结束时比较,差异均有统计学意义(P<0.05)。神经阻滞前两组动脉压和心率比较,差异均无统计学意义(P>0.05)。神经阻滞30 min和手术结束时两组动脉压和心率比较,差异均有统计学意义(P<0.05)。超声组术后疼痛评分和并发症发生率均低于传统组,差异均有统计学意义(P<0.05)。结论超声引导下臂丛神经麻醉阻滞能为患者提供更好的神经阻滞效果,同时能减少患者痛苦,降低术后疼痛及并发症发生,安全有效,值得临床借鉴推广。

Objective To investigate the application value of ultrasound-guided brachial plexus block in upper limb surgery.Methods From January 2019 to December 2021,a total of 126 patients who underwent upper limb surgery in our hospital and received traditional anatomical positioning for brachial plexus block were selected as the traditional group,and 174 patients who underwent upper limb surgery in our hospital and received ultrasoundguided positioning for brachial plexus block were selected as the ultrasound group.The clinical data of the two groups were analyzed.Results The onset time of anesthesia in the ultrasound group was significantly shorter than that in the traditional group,and the duration of nerve block anesthesia was significantly longer than that in the traditional group(P<0.05).The blood flow,resistance index,pulsation index and end diastolic velocity in the ultrasound group were significantly better than those in the traditional group(P<0.05).There was no significant difference in systolic peak velocity between the two groups(P>0.05).There was no significant difference in arterial pressure and heart rate before nerve block,30 min after nerve block and at the end of operation in the ultrasound group(P>0.05).The arterial pressure and heart rate in the traditional group were significantly different before nerve block,30 min after nerve block and the end of operation(P<0.05).There was no significant difference in arterial pressure and heart rate between the two groups before nerve block(P>0.05).There were significant differences in arterial pressure and heart rate between the two groups at 30 min after nerve block and at the end of operation(P<0.05).The postoperative pain score and complication rate in the ultrasound group were significantly lower than those in the traditional group(P<0.05).Conclusion Ultrasoundguided brachial plexus block can provide better nerve block effect,reduce the pain of patients,reduce the incidence of postoperative pain and complications,which is safe and effective,and worthy of clinical reference and promotion.